HIV IN MASSACHUSETTSAnalysis of the clinics assessed by a site review form we created based on the...
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HIV IN MASSACHUSETTS Sneha Bagchi, Danielle Kerrigan, Nathan Petrou, Schyla Wante UMMS Population Health Clerkship Background HIV Program Funding Demographics Barriers to Care Case Management & Resources Conclusion References Massachusetts Integrated HIV/AIDS Prevention and Care Plan More than 250 people across the commonwealth collaborated to build the Massachusetts Integrated HIV/AIDS Prevention and Care Plan. • Goals of the plan: reducing the impact of HIV, improving health outcomes, reducing HIV-related health disparities • Goal by 2021: 90/90/90 plan to improve outcomes (90% diagnosed; 90% retained in care; 90% virally suppressed) Goal of Clerkship Our goal was to analyze 4 HIV clinics according to the guidelines set by the Care Plan. Clinics assessed: • Edward M. Kennedy Community Health Center (EMK) • Family Health Center in Worcester (FHCW) • Greater Lawrence Family Health Center (GLFHC) • UMass Infectious Disease Clinic (UMID) Analysis of the clinics assessed by a site review form we created based on the goals set by the Care Plan. Demographics for the 4 clinics were assessed through intake forms and site analysis. Intake forms generally include sex at birth, current gender, age, race, ethnicity, mode of transmission of HIV, and past medical history. All 4 clinics funded through patient revenue, Ryan White CARE program, and MA Department of Public Health (DPH). Ryan White CARE program: • Passed in 1990 • Part A: Federal funding to Boston’s Health Resources and Services Administration (HRSA) HRSA allocates money to HIV clinics throughout the state Covers case management, peer support, transportation • Part B: HIV Drug Assistance Program (HDAP) Covers cost of HIV medications In MA, most medications covered by MassHealth, HDAP used for copays • Part C: federal funding given directly to community-based organizations Covers provider support time, health insurance assistance, Continuous Quality Improvement database, housing support, etc. • Patients with active mental health and/or substance abuse issues often have difficulty adhering to treatment regimens Long waiting lists for detox and/or therapy perpetuate lower rates of viral suppression among these individuals • Homelessness and unstable housing are stressors for patients who need to take and refill their medication, causing difficulty with contacting patients for follow-up • Lack of education and negative stigma around HIV diagnosis in African immigrant and Latino communities perpetuate lower rates of viral suppression At the 4 HIV clinics, success in treating HIV patients is measured through viral suppression, which is achieved through strict adherence to a prescribed anti-retroviral therapy. Medical management teams address barriers to adherence or treatment through case managers and multi-factorial social services. All the clinics that we reviewed were largely successful in their trajectory towards the state’s 90/90/90 plan. Shortage and underuse of certain resources along with stigma within certain communities are areas in which clinics can focus their efforts in the future. Massachusetts Integrated HIV/AIDS Prevention and Care Plan. HIV/AIDS Services in the Commonwealth: 2017-2021. Massachusetts Department of Public Health (MDPH); Bureau of Infectious Disease and Laboratory Sciences (BIDLS); Office of HIV/AIDS (OHA). We would like to thank Philip Bolduc, MD, and HIV care team members and staff at EMK, FHCW, GLFHC, UMID, and AIDS Project Worcester for welcoming us during this Population Health Clerkship. 0% 20% 40% 60% 80% 100% EMK FHCW GLFHC UMID Massachusetts Figure 4. Rates of Viral Suppression for Patients on ART Virally Suppressed Not Virally Suppressed 0% 20% 40% 60% 80% EMK FHCW GLFHC UMID Massachusetts Figure 2. Modes of Transmission Heterosexual MSM IVDU Other/Undetermined Acknowledgements • Patients assigned to case managers based on high-acuity scores during intake • Alerted when viremia hasn’t been checked in 6 months, clinics have regular case review • All 4 sites have Pre-Exposure Prophylaxis (PrEP) services. Range of patients eligible for PrEP in these communities is narrow. • Syringe Service Programs (SSPs) are available in both Lawrence and Worcester • Other services provided: Recommendations 0% 20% 40% 60% 80% 100% EMK FHCW GLFHC UMID Massachusetts Figure 1. Ethnicity Non Hispanic Hispanic Other • PCPs should be educated about managing HIV+ patients • PrEP is underused by providers and patients at high risk, education needed in these areas • Education and outreach to Latino and African immigrant communities to destigmatize HIV diagnosis • Increase number of SSPs in Worcester and Lawrence areas, with HIV/STI testing and linkage to care on site • Thoroughly address sexual health at annual provider visits Figure 2. Modes of Transmission of HIV across 4 clinics. • Across the four sites, heterosexual transmission is the most common exposure mode. GLFHC has the highest percentage of heterosexual transmission • MSM is the most frequent mode of transmission across MA Figure 3. Genders of HIV patients in care compared to the gender composition of HIV patients in Massachusetts Figure 1. Ethnicities of patients in care. Data obtained from clinics and HIV/AIDS Prevention and Care Plan. • FHCW serves the African immigrant and refugee populations of Worcester, many of whom self-identify as Non-Hispanic Figure 4. For patients taking Anti-Retroviral Therapy (ART) FHCW, GLFHC, and UMID have viral suppression rates above 90% at this time, higher than the state average. Funding Source: This product was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U1OHA29294 (AIDS Education and Training Centers) awarded to the University of Massachusetts Medical School (UMMS). No percentage of this project was financed with non-governmental sources. This information of content and conclusions are those of the authors and should not be construed as the official position or policy of, no should any endorsements be inferred by HRSA, HHS or the U.S. Government. Insurance Assistance Community Health Workers Mobile Care Clinics Housing Assistance STI Testing Transportation Detox Referrals Home Visits Figure 3.
Transcript of HIV IN MASSACHUSETTSAnalysis of the clinics assessed by a site review form we created based on the...
HIV IN MASSACHUSETTS Sneha Bagchi, Danielle Kerrigan, Nathan Petrou, Schyla Wante
UMMS Population Health Clerkship
Background
HIV Program Funding
Demographics Barriers to Care
Case Management & Resources
Conclusion
References
Massachusetts Integrated HIV/AIDS Prevention and Care Plan More than 250 people across the commonwealth collaborated to build the Massachusetts Integrated HIV/AIDS Prevention and Care Plan.
• Goals of the plan: reducing the impact of HIV, improving health outcomes, reducing HIV-related health disparities
• Goal by 2021: 90/90/90 plan to improve outcomes (90% diagnosed; 90% retained in care; 90% virally suppressed)
Goal of Clerkship Our goal was to analyze 4 HIV clinics according to the guidelines set by the Care Plan.
Clinics assessed: • Edward M. Kennedy Community Health Center (EMK) • Family Health Center in Worcester (FHCW) • Greater Lawrence Family Health Center (GLFHC) • UMass Infectious Disease Clinic (UMID)
Analysis of the clinics assessed by a site review form we created based on the goals set by the Care Plan.
Demographics for the 4 clinics were assessed through intake forms and site analysis. Intake forms generally include sex at birth, current gender, age, race, ethnicity, mode of transmission of HIV, and past medical history.
All 4 clinics funded through patient revenue, Ryan White CARE program, and MA Department of Public Health (DPH). Ryan White CARE program:
• Passed in 1990 • Part A: Federal funding to Boston’s Health Resources and
Services Administration (HRSA) HRSA allocates money to HIV clinics throughout the
state Covers case management, peer support, transportation
• Part B: HIV Drug Assistance Program (HDAP) Covers cost of HIV medications In MA, most medications covered by MassHealth,
HDAP used for copays • Part C: federal funding given directly to community-based
organizations Covers provider support time, health insurance
assistance, Continuous Quality Improvement database, housing support, etc.
• Patients with active mental health and/or substance abuse issues often have difficulty adhering to treatment regimens Long waiting lists for detox and/or therapy perpetuate lower
rates of viral suppression among these individuals • Homelessness and unstable housing are stressors for patients
who need to take and refill their medication, causing difficulty with contacting patients for follow-up
• Lack of education and negative stigma around HIV diagnosis in African immigrant and Latino communities perpetuate lower rates of viral suppression
At the 4 HIV clinics, success in treating HIV patients is measured through viral suppression, which is achieved through strict adherence to a prescribed anti-retroviral therapy. Medical management teams address barriers to adherence or treatment through case managers and multi-factorial social services. All the clinics that we reviewed were largely successful in their trajectory towards the state’s 90/90/90 plan. Shortage and underuse of certain resources along with stigma within certain communities are areas in which clinics can focus their efforts in the future.
Massachusetts Integrated HIV/AIDS Prevention and Care Plan. HIV/AIDS Services in the Commonwealth: 2017-2021. Massachusetts Department of Public Health (MDPH); Bureau of Infectious Disease and Laboratory Sciences (BIDLS); Office of HIV/AIDS (OHA).
We would like to thank Philip Bolduc, MD, and HIV care team members and staff at EMK, FHCW, GLFHC, UMID, and AIDS Project Worcester for welcoming us during this Population Health Clerkship.
0%
20%
40%
60%
80%
100%
EMK FHCW GLFHC UMID Massachusetts
Figure 4. Rates of Viral Suppression for Patients on ART
Virally Suppressed Not Virally Suppressed
0%
20%
40%
60%
80%
EMK FHCW GLFHC UMID Massachusetts
Figure 2. Modes of Transmission
Heterosexual MSM IVDU Other/Undetermined
Acknowledgements
• Patients assigned to case managers based on high-acuity scores during intake
• Alerted when viremia hasn’t been checked in 6 months, clinics have regular case review
• All 4 sites have Pre-Exposure Prophylaxis (PrEP) services. Range of patients eligible for PrEP in these communities is narrow.
• Syringe Service Programs (SSPs) are available in both Lawrence and Worcester
• Other services provided:
Recommendations
0%
20%
40%
60%
80%
100%
EMK FHCW GLFHC UMID Massachusetts
Figure 1. Ethnicity
Non Hispanic Hispanic Other
• PCPs should be educated about managing HIV+ patients • PrEP is underused by providers and patients at high risk,
education needed in these areas • Education and outreach to Latino and African immigrant
communities to destigmatize HIV diagnosis • Increase number of SSPs in Worcester and Lawrence areas, with
HIV/STI testing and linkage to care on site • Thoroughly address sexual health at annual provider visits
Figure 2. Modes of Transmission of HIV across 4 clinics. • Across the four sites, heterosexual transmission is the most
common exposure mode. GLFHC has the highest percentage of heterosexual transmission
• MSM is the most frequent mode of transmission across MA
Figure 3. Genders of HIV patients in care compared to the gender composition of HIV patients in Massachusetts
Figure 1. Ethnicities of patients in care. Data obtained from clinics and HIV/AIDS Prevention and Care Plan.
• FHCW serves the African immigrant and refugee populations of Worcester, many of whom self-identify as Non-Hispanic
Figure 4. For patients taking Anti-Retroviral Therapy (ART) FHCW, GLFHC, and UMID have viral suppression rates above 90% at this time, higher than the state average.
Funding Source: This product was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U1OHA29294 (AIDS Education and Training Centers) awarded to the University of Massachusetts Medical School (UMMS). No percentage of this project was financed with non-governmental sources. This information of content and conclusions are those of the authors and should not be construed as the official position or policy of, no should any endorsements be inferred by HRSA, HHS or the U.S. Government.
Insurance Assistance Community Health Workers Mobile Care Clinics Housing Assistance
STI Testing Transportation Detox Referrals Home Visits
Figure 3.
